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 Thought Leaders

Abandoning ICD-10

This CMIO supports letting go of ICD-10 in favor of SNOMED-CT or ICD-11.

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   By Jonathan Handler, M.D., April 2013

Transitioning to ICD-10 is predicted to cost $1.64 billion, and some believe actual costs for providers could be 10 times higher. The AMA urged a halt to the ICD-10 transition, and we agree. Every dollar spent on ICD-10 is one less dollar for vaccinations, cancer screenings and other basic needs.

Experts say ICD-10 efforts should start with physician documentation. Burdensome documentation has already eroded clinician time with the patient; with ICD-10, it will get worse. Patients already wait months to see their doctors; add more documentation overhead and patients will wait even longer. This is not just an inconvenience; it’s literally a matter of life and death. The other day, I read about the death of an alumnus from my high school. He visited an emergency department, but the wait was too long so he left. He died of untreated and undiagnosed abdominal bleeding.

It’s just not safe to add more overhead that steals time from clinical care. Some might suggest the answer is just to hire more doctors. Unfortunately, even if we had the funding, we’re already facing a physician shortage and can’t even cover our current healthcare needs. High costs and limited patient access to care are among our greatest public health threats. Transitioning to ICD-10 worsens both.

What do we get in return? ICD-10 codes are more specific than ICD-9 codes. Some say this will reduce payer requests for additional documentation while facilitating disease surveillance, medical research and payment for quality. Even if we accept the idea of cramming a “mini medical record” into a billing code to support these goals, ICD-10 is not the right terminology for the job. SNOMED-CT is a much better fit.

ICD-10 is more than 20 years old and woefully out of date. For example, ICD-10 encodes the quadrant in which a breast cancer is located (which has minimal value), but not its estrogen receptor status (which has huge value). Compositional SNOMED-CT (where SNOMED-CT codes can be strung together, such as “estrogen receptor positive tumor” and “breast cancer”) is a simpler, better and more useful solution than ICD-10.

Unlike ICD-10, many U.S. clinicians have used SNOMED-CT. Even back in 2008, a study1  found that nearly 20 percent of responding vendors said their EHRs already utilized SNOMED-CT for problem lists and other clinical data. In 2014, all clinicians wishing to qualify for Stage 2 meaningful use (MU) will have to document problem lists in SNOMED-CT. However, when they code those very same problems as “diagnoses” they will be forced to use ICD-10. To facilitate this process, the National Library of Medicine has created an interactive tool called I-MAGIC to help clinicians convert SNOMED-CT to ICD-10 to enable reimbursement and MU compliance.

Is this really the best use of clinician time? Why not let the clinicians document problems and diagnoses in SNOMED-CT – the most detailed and clinically relevant terminology – and let the payers do their own translation to ICD-10 if they think that’s necessary for their business processes?

Believe it or not, the story worsens. ICD-10 becomes mandatory in October 2014. However, ICD-11 is due for release just a few months later, in 2015. Now that we’ve delayed implementation of ICD-10 for more than two decades, are we seriously going to burn massive healthcare dollars and steal time from patients by rushing to implement a now outdated and flawed terminology less than a year before a new and better version is released?

Any good idea should be validated by other experts. Fortunately, I’m not the only one suggesting that ICD-10 should be abandoned in favor of SNOMED-CT (or possibly ICD-11, depending on how that turns out). Both the American College of Physicians and the Texas Medical Association have made similar recommendations2.

Let’s not waste billions and hinder care just to replace one bad coding system with another – especially when we have a much better alternative that many already use today. Let’s abandon ICD-10 and either wait a few months for ICD-11 or (better yet) use compositional SNOMED-CT instead. HMT

About the Author

Jonathan Handler, M.D., is chief medical information officer, M*Modal. For more on M*Modal: www.rsleads.com/304ht-208

  1. Kathy Giannangelo, "SNOMED CT Survey: An Assessment of Implementation in EMR/EHR Applications," Perspectives in Health Information Management, 2008; 5: 7 (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2396499/)
  2. Ken Terry, "ICD-10 and SNOMED-CT: Better together?" FierceHealthIT, May 24, 2012 (http://www.fiercehealthit.com/story/diagnostic-coding-sets-snomedct-versus-icd10-/2012-05-23)

Tags:  Thought Leaders